早期益生菌结合肠内营养干预对ICU老年SAP患者肠道耐受性和炎症介质水平的影响

Effect of Early Probiotics combined with Enteral Mutrition Intervention on Intestinal Tolerance and Inflammatory Mediators in Elderly Patients with SAP in ICU

目的:探究早期益生菌结合肠内营养(EN)干预应用于老年重症急性胰腺炎(SAP)患者的临床效果。方法:对116例老年SAP患者临床资料进行回顾性分析,均实施常规综合性疗法,仅采取早期EN干预者纳入对照组(n=54),早期给予益生菌结合EN干预者纳入结合组(n=62)。比较干预前及干预7d后,两组患者血清炎症介质[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]、肠黏膜功能性指标[二胺氧化酶(DAO)、右旋乳酸(D-Lac)、内毒素]、体液免疫功能性指标[免疫球蛋白A(IgA)、IgG、IgM]水平变化,分析两组患者住院记录指标、存活时间及7d内肠道不耐受症状发生情况差异。结果:干预7d后,两组血清IL-6、IL-10、TNF-α、DAO、D-Lac、内毒素水平均较干预前有显著下降,且结合组明显低于同一时间对照组(均P<0.05);两组血清IgA、IgG、IgM水平均较干预前有显著提升,且结合组明显高于同一时间对照组(均P<0.05)。干预7d内,结合组患者腹胀、腹泻发生率均明显低于对照组(均P<0.05),而两组恶心/呕吐、便秘发生率比较均无统计学意义(均P>0.05)。两组存活时间比较无统计学意义(P>0.05);最终存活患者中,结合组腹痛缓解时间、经口进食时间、住ICU时间及住院时间均明显少于对照组(均P<0.05)。结论:早期益生菌可有效改善老年SAP患者对EN的耐受性,有助于提高营养干预效果,并促进病情转归,临床应用价值较高。

Objective:To explore the clinical effects of early probiotics combined with enteral nutrition(EN)in elderly patients with severe acute pancreatitis(SAP).Methods:The clinical data of 116 elderly SAP patients were retrospectively analyzed.All patients were treated with conventional comprehensive therapy.Patients only with early EN intervention were included in control group(n=54),and patients with early probiotics combined with EN intervention were included in combined group(n=62).Before intervention and after 7d of intervention,the serum inflammatory mediators[interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)],intestine mucosal functional indicators[diamine oxidase(DAO),dextrolactic acid(D-Lac),endotoxin]and humoral immune functional indicators[immunoglobulin A(IgA),IgG,IgM]were compared between the two groups,and the hospitalization record indexes,survival time and occurrence of intestinal intolerance symptoms within 7d were analyzed in the two groups.Results:After 7d of intervention,the levels of serum IL-6,IL-10,TNF-α,DAO,D-Lac and endotoxin in the two groups were significantly lower than those before intervention,and the levels in combined group were significantly lower than those in control group at the same time period(all P<0.05).The levels of serum IgA,IgG and IgM in the two groups were significantly higher than those before intervention,and the levels in combined group were significantly higher than those in control group at the same time period(all P<0.05).Within 7d after intervention,the incidence rates of abdominal distension and diarrhea in combined group were significantly lower than those in control group(all P<0.05),but there were no significant differences in the incidence rates of nausea/vomiting and constipation between the two groups(all P>0.05).There was no significant difference in survival time between the two groups(P>0.05).Among surviving patients,the abdominal pain relief time,oral feeding time,ICU stay and hospital stay in combined group were significantly lower than those in control group(all P<0.05).Conclusion:Early probiotics can effectively improve the EN tolerance of elderly SAP patients,help to improve the nutritional intervention effects,and promote the outcomes of disease,and it has high clinical application value.